Provider Demographics
NPI:1518532936
Name:JONES, CHARLENE CELESTINO (RD, CSG)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:CELESTINO
Last Name:JONES
Suffix:
Gender:F
Credentials:RD, CSG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13244 E MESQUITE FLAT SPRING DR
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641-2501
Mailing Address - Country:US
Mailing Address - Phone:619-518-3549
Mailing Address - Fax:
Practice Address - Street 1:1625 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-4330
Practice Address - Country:US
Practice Address - Phone:520-694-7528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86081127133VN1101X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1101XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Gerontological